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      Does Estimated Pulse Wave Velocity Add Prognostic Information?: MORGAM Prospective Cohort Project.

      1 , 2 , 3 , 4 , 1 , 5 , 6 , 7 , 8 , 9 , 10 , 10 , 10 , 11 , 12 , 13 , 14 , 15 , 15 , 15 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27
      Hypertension (Dallas, Tex. : 1979)
      Ovid Technologies (Wolters Kluwer Health)
      cardiovascular risk, prognosis, pulse wave velocity, reclassification

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          Abstract

          The Reference Values for Arterial Stiffness Collaboration has derived an equation using age and mean blood pressure to estimated pulse wave velocity (ePWV), which predicted cardiovascular events independently of Systematic COoronary Risk Evaluation (SCORE) and Framingham Risk Score. The study aim was to investigate the independent association between ePWV and clinical outcomes in 107 599 apparently healthy subjects (53% men) aged 19 to 97 years from the MORGAM Project who were included between 1982 and 2002 in 38 cohorts from 11 countries. Using multiple Cox-regression analyses, the predictive value of ePWV was calculated adjusting for country of inclusion and either SCORE, Framingham Risk Score, or traditional cardiovascular risk factors (age, sex, smoking, systolic blood pressure, body mass index [BMI], total and high-density lipoprotein cholesterol). Cardiovascular mortality consisted of fatal stroke, fatal myocardial infarction, or coronary death, and the composite cardiovascular end point consisted of stroke, myocardial infarction, or coronary death. Model discrimination was assessed using Harrell's C-statistic. Adjusting for country and logSCORE or Framingham Risk Score, ePWV was associated with all-cause mortality (hazard ratio, 1.23 [95% CI 1.20-1.25] per m/s or 1.32 [1.29-1.34]), cardiovascular mortality (1.26 [1.21-1.32] or 1.35 [1.31-1.40]), and composite cardiovascular end point (1.19 [1.16-1.22] or 1.23 [1.20-1.25]; all P<0.001). However, after adjusting for traditional cardiovascular risk factors, ePWV was only associated with all-cause mortality (1.15 [1.08-1.22], P<0.001) and not with cardiovascular mortality (0.97 [0.91-1.03]) nor composite cardiovascular end point (1.10 [0.97-1.26]). The areas under the last 3 receiver operator characteristic curves remained unchanged when adding ePWV. Elevated ePWV was associated with subsequent mortality and cardiovascular morbidity independently of systematic coronary risk evaluation and Framingham Risk Score but not independently of traditional cardiovascular risk factors.

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          Author and article information

          Journal
          Hypertension
          Hypertension (Dallas, Tex. : 1979)
          Ovid Technologies (Wolters Kluwer Health)
          1524-4563
          0194-911X
          June 2020
          : 75
          : 6
          Affiliations
          [1 ] From the Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark (J.K.K.V.-N., A.L.).
          [2 ] Department of Cardiology, Rigshospitalet (J.K.K.V.-N.), University of Copenhagen, Denmark.
          [3 ] Department of Clinical Pharmacology and INSERM U 970, team 7, Paris CV Research Center (PARCC), Hôpital Européen Georges Pompidou, France (S.L.).
          [4 ] Department for Clinical Sciences Medicine, University Hospital, Malmö, Sweden (P.M.N.).
          [5 ] Department of Clinical Medicine, Faculty of Health and Medical Sciences (A.L.), University of Copenhagen, Denmark.
          [6 ] Department of Cardiology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark (T.S.G.S.).
          [7 ] Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Odense University Hospital, Denmark (S.V.G.).
          [8 ] Department of Cardiology, North Zealand Hospital, Hilleroed, Denmark (M.P.).
          [9 ] Department of Internal Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT (M.P.).
          [10 ] Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, National Centre of Epidemiology Surveillance and Health Promotion, National Institute of Health, Rome, Italy (L.P., S.G., C.D.).
          [11 ] Centre for Public Health, The Queen's University of Belfast, Northern Ireland (F.K.).
          [12 ] University of Milano-Bicocca and Policlinico di Monza, Italy (G.M.).
          [13 ] Research Centre on Public Health, University of Milano Bicocca, Villa Serena, Monza, Italy (G.C.).
          [14 ] Research Centre in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Italy (G.V.).
          [15 ] Finnish Institute for Health and Welfare (THL), Helsinki, Finland (K.K., V.S., J.K., T.P.).
          [16 ] Catalan Department of Health, Barcelona, Spain (S. Sans).
          [17 ] Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse Cedex 9, France (J.F.).
          [18 ] Institut Pasteur de Lille, Lille Cedex, France (J.D.).
          [19 ] Department of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umeå University, Sweden (S. Söderberg).
          [20 ] Department of Epidemiology and Public Health, University of Strasbourg, University Hospital of Strasbourg, France (M.M.).
          [21 ] Department of Epidemiology, CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland (W.D.).
          [22 ] Lithuanian University of Health Sciences, Institute of Cardiology, Kaunas (A.T.).
          [23 ] German Research Center for Environmental Health, Institute of Epidemiology II, Neuherberg, Germany (A.P.).
          [24 ] German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Germany (H.B.).
          [25 ] Institute of Community Medicine, University of Tromsø, Norway (I.N.).
          [26 ] Department of Internal Medicine, Holbaek Hospital, Denmark (M.H.O.).
          [27 ] Centre of Individualized Medicine in Arterial Diseases (CIMA), Department of Regional Health Research, University of Southern Denmark (M.H.O.).
          Article
          10.1161/HYPERTENSIONAHA.119.14088
          32275189
          9f971509-8413-4971-8814-0e06af1b2bef

          cardiovascular risk,prognosis,pulse wave velocity,reclassification

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